Hormones

Feminizing Hormones

Feminizing hormones are medications (e.g. estrogen, anti-androgens, progestins) used to develop physical characteristics that are in line with one's gender identity or gender expression.

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This page sets out the advantages and disadvantages of common estrogen, testosterone blocker and progesterone therapies, as well as the expected effects and potential risks of feminizing hormones. The list of therapies is not exhaustive. Talk to your health care provider to determine the best fit for you.

Common therapies

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Your health care provider will help you tailor your hormone therapy to meet your goals, health needs and budget. Your hormone therapy may include any of the following:

estrogen alone

estrogen and testosterone blockers

estrogen and testosterone blockers and progesterone

testosterone blockers alone (this is not safe for long periods of time)

Common estrogen therapies

Oral estrogen

brand name: Estrace

description: a pill you swallow or dissolve under your tongue each day

advantages: less expensive (around $14 a month)

disadvantages: higher cardiovascular risk for people over 40, especially with other risk factors

Estrogen patch

brand names: Estradot, Estraderm, Oesclim

description: a patch you wear on your skin that gets changed twice a week

advantages: lower cardiovascular risk for people over 40, especially with other risk factors

disadvantages: more expensive (around $25 a month). some people have a skin reaction to the adhesive in the patch

Injectable estrogen (estradiol valerate)

description: a substance you inject every two weeks

advantages: possibly lower cardiovascular risk for people over 40, especially with other risk factors

disadvantages: more expensive and less widely available. some people find injections to be painful. improper injection can be dangerous

Common testosterone blocker therapies

Spironolactone

brand name: Aldactone

description: a pill that you swallow once or twice a day

advantages: most common because it’s less expensive ($22 a month) and usually well tolerated

disadvantages: some people find pills hard to swallow. may make you have to pee more often and may require dietary restrictions

Finasteride

description: a pill that you put under your tongue once a day or every other day. usually used with an anti-androgen therapy

advantages: can help slow hereditary hair loss

disadvantages: costs around $60 a month

Common progesterone therapies

The use of progesterone in feminizing regimens is controversial. Most guidelines do not recommend the use of it as part of a standard regimen but discuss the possibility of using it as an adjunctive medication for a period of time.

Benefits may include positive effects on the development of the nipple and areola and improved libido, but this is unproven.

Common side effects include weight gain, edema, lipid changes and depression. Taking progesterone along with estrogen as compared to taking estrogen alone is believed to increase the risk of strokes, pulmonary emboli, breast cancer and heart disease.

Medroxyprogesterone

brand name: Provera

description: a pill you take daily

advantages: widely available and less expensive at around $33 a month. may help with breast development, although this is controversial

disadvantages: thought to be higher risk

Micronized progesterone

brand name: Prometrium

description: a pill you take daily

advantages: thought to be lower risk than medroxyprogesterone

disadvantages: more expensive at about $90 a month

Effects

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Expected effects of feminizing hormone therapies

Breast development

usually starts in 3 to 6 months

breasts reach full size in 2 to 3 years

size varies; A or B cup size is typical

a permanent change

Body fat redistribution

usually starts in 3 to 6 months

reaches maximum effect in 2 to 5 years

less fat on abdomen

more fat on buttocks, hips and thighs

not a permanent change if you stop taking hormones

Reduced muscle mass & strength

usually starts in 3 to 6 months

reaches maximum effect in 1 to 2 years

reduced muscle and strength in upper body

not a permanent change if you stop taking hormones

Softening of skin

usually starts in 3 to 6 months

skin will be softer and less oily

not a permanent change if you stop taking hormones

Less facial & body hair

usually starts in 6 to 12 months

maximum effect in more than 3 years

body hair will appear less noticeable

body hair will grow more slowly

beard and mustache may grow more slowly and appear less noticeable, but will not go away

if you have male pattern hair loss, it may slow down

hair that has already been lost likely will not grow back

not a permanent change if you stop taking hormones

Reduced sex drive

usually starts in 1 to 3 months

reaches maximum effect in 1 to 2 years

fewer morning erections

fewer spontaneous erections

not a permanent change if you stop taking hormones

Fertility

timeline varies

sperm may no longer reach maturity

won’t produce as much semen

may not be able to get hard enough for penetrative sex

may become permanently unable to make someone pregnant (but birth control is still recommended)

Smaller gonads (testes)

usually starts in 3 to 6 months

maximum effect in 2 to 3 years

may shrink down to half their initial size

may or may not be a permanent change if you stop taking hormones

Emotional changes

overall emotional state may or may not change; this varies from person to person

There is either no increased risk of breast cancer or the research is inconclusive.

Mood changes are variable; they may be positive or negative, or may have an adjustment period. Many people experience positive mood changes after starting hormone therapy. Any mood changes that cause you concern should be discussed with your primary care provider.